Insulin degludec compared with insulin glargine in insulin-naive patients with type 2 diabetes: A 26-week, randomized, controlled, Pan-Asian, treat-to-target trial

IntroductionInsulin degludec (IDeg) is an ultra-long-acting basal insulin with a consistent action profile of >42h. This trial compared the efficacy and safety of IDeg with insulin glargine (IGlar) in insulin-naive Asian patients with type 2 diabetes. Materials and MethodsIn this multinational, 26-week, open-label, treat-to-target trial, 435 participants (202 females, 233 males; mean age 58.6years; mean body mass index 25kg/m(2); mean glycated hemoglobin [HbA(1c)] 8.5%) were randomized (2:1) to IDeg or IGlar, each administered once daily with 1 oral antidiabetic drug(s) (OAD). ResultsAfter 26weeks, HbA(1c) had decreased by 1.24 and 1.35% in the IDeg and IGlar groups, respectively (treatment difference [IDeg - IGlar] 0.11%, 95% confidence interval [CI] -0.03 to 0.24), confirming non-inferiority. Rates of overall confirmed hypoglycemia were similar for IDeg and IGlar during the full trial period (3.0 vs 3.7 episodes/patient-year of exposure [PYE]; rate ratio [RR] 0.82, 95% CI 0.60 to 1.11, P=0.20), but significantly lower (by 37%) for IDeg during the maintenance period (from week 16 onward; RR 0.63, 95% CI 0.42 to 0.94, P=0.02). No significant difference in the rate of nocturnal confirmed hypoglycemia was found between IDeg and IGlar in the full trial period (0.8 vs 1.2 episodes/PYE; RR 0.62, 95% CI 0.38 to 1.04, P=0.07) or maintenance period (RR 0.52, 95% CI 0.27 to 1.00, P=0.05). Adverse event rates were similar between treatments. ConclusionsInitiating insulin therapy with IDeg in Asian patients with type 2 diabetes, inadequately controlled with OADs, provides similar improvements in long-term glycemic control to IGlar, but at a significantly lower rate of overall confirmed hypoglycemia once stable glycemic control and insulin dosing are achieved. This trial was registered with www.clinicaltrials.gov (no. NCT01059799).